Reform Of Health Care Assuming Greater Importance

November 14, 1992|By JOHN MacDONALD; Senior Washington Correspondent

WASHINGTON — There it was near the top of Bill Clinton's agenda.

Health-care reform in the past year has shot from virtually no place on the political radar screen to No. 3 on the list of priorities of the president-elect, just behind getting the economy growing and providing new jobs.

"We have to have a plan to deal with the exploding costs of health care, and the fact that 100,000 Americans a month are losing their coverage, something that is ballooning the Medicaid budgets of this state [Arkansas] and virtually every other one in the country," Clinton reiterated this week at his first post-election press conference.

The problem, as Clinton soon will learn, is that while the country wants health-care reform, it does not know what reform should look like. That means Clinton will have to show considerable leadership. He'll have to get straight in his own mind what he wants to do, then use the considerable powers of the White House to build a consensus behind his plan.

That's a tough job, because just about any plan Clinton comes up with will create winners and losers. And whoever the losers are will run to their member of Congress, demanding he or she immediately step in and improve their position.

Just how fragmented public opinion is -- and how large a task Clinton faces in building a consensus -- is clear from a poll the Hartford-based Aetna Life & Casualty Co. commissioned on Election Day. The telephone survey of 1,200 Americans who said they voted was done by the Washington polling firm of Frederick/Schneiders Inc., and had a margin of error of plus or minus three percentage points.

From a political perspective, perhaps the most interesting figure in the poll was that 69 percent rated health care a very important issue in deciding whom they supported for president, behind only the economy (82 percent) and the deficit (76 percent). That suggests the pressure for the president and Congress to act will be considerable next year.

To get an idea of how quickly this issue is rising in public recognition, consider a report prepared for Aetna in July by Powell Tate, a Washington public relations firm. Based on an analysis of more than 60 polls conducted during the three previous years, the firm reported: "Most respondents rank health care far behind such issues as the economy or drugs. Moreover, and to our surprise, a study of the research reveals no visible upward trend in the importance of health care issues among the general public between 1989 and the present."

Officials at both Aetna and Powell Tate said the Election Day poll clearly showed health-care reform rapidly rising as an issue that concerns voters. Otherwise, they insisted, the results were neither surprising nor alarming. Still, the numbers are interesting, because they provide a recent snapshot of public opinion and suggest some of the contradictions policy makers will have to grapple with in the months ahead.

On the most basic of questions, for example, voters were equally divided between those who favored completely overhauling the current system (48 percent) and those who preferred maintaining and improving today's basic system (49 percent).

On the face of it, that narrow split would not seem especially reassuring to Connecticut-based insurers, who could find themselves hurting if voters demanded sweeping change. But House Speaker Thomas S. Foley, D-Wash., said recently he does not foresee the adoption of a Canadian-style, government-run plan, the most radical change considered this year.

The Aetna survey suggested Foley may have been speaking for the majority of Americans. Fifty-four percent agreed the existing U.S. health-care system has many good qualities "and we should keep it but try to make it better." By contrast, 43 percent said the existing system "is so flawed that we should get rid of it and start over." Analysts said the difference between the two questions is that, when reminded, voters agreed there are good aspects to the present system.

Answering another question, 70 percent favored overhaul that had the government and private industry working as partners to provide health-care coverage, compared with only 26 percent who supported a plan in which the government runs the whole show.

Complicating the picture, though, 48 percent said a government-operated plan would be much better or somewhat better than the current system, compared with 44 percent who said it would be somewhat worse or much worse. And among Clinton voters, the number of those believing a government-run plan would be better increased to 60 percent, a sign of where pressure on the new president will come from.

Foley is now predicting it may take "somewhat longer" than the first 100 days for Clinton to put his plan together. If that was an invitation to take some extra time, the president-elect might be wise to accept. With expectations for health-care reform so high, he cannot afford to make a mistake.

The writer is the senior correspondent in The Courant's Washington bureau